Citramon: instructions for use, tablets increase or decrease blood pressure, composition

Compound

The composition of Citramon tablets traditionally included: 240 mg of acetylsalicylic acid (ASA), 180 mg of phenacetin , 30 mg of caffeine , 15 mg of cocoa, 20 mg of citric acid.
However, at present, the classic recipe for making the drug is not used due to the withdrawal of one of its active components, phenacetin, (this is due to the high nephrotoxicity of the substance).

Numerous manufacturers produce medicines whose names contain the word “Citramon”, but they all have a slightly modified composition, in which paracetamol is used phenacetin .

Tablets from different manufacturers maintain the same uniformity of active ingredients, but the concentration of each of them may differ.

Citramon P, Citramon U and Citramon M contain active components (ASA, paracetamol and caffeine) in the same concentration as in the original drug. But in Citramon-Forte their concentration is different: each tablet contains 320 mg of ASA, 240 mg of paracetamol and 40 mg of caffeine.

Citramon Borimed tablets contain 220 mg of ASA, 200 mg of paracetamol and 27 mg of caffeine. The concentration of these substances in Citramon-LekT tablets is, respectively, 240 mg, 180 mg and 27.5 mg.

But the main difference between Citramon Ultra and Citramon is the presence of a film shell, which makes the tablet easier to swallow, acts as a reliable barrier between the mucous membrane of the digestive canal and the active substances contained in the tablets (in particular, the shell protects the stomach from the aggressive effects of ASA) and accelerates the absorption of the drug.

"Citramon": composition and other characteristics

"Citramon" is an anesthetic that prevents inflammatory processes and also has an antipyretic effect. The only form of release is tablets. They are packaged in cardboard packages, each containing 10 or 6 pieces.

The active ingredient is acetylsalicylic acid (240 mg per tablet). The following are used as auxiliary components:

citric acid (20 mg);
phenacetin (180 mg);
caffeine (20 mg).

The composition and dosage of components may vary significantly, as determined by manufacturers. The features of the tablet may also differ. For example, “Citramon Ultra”, unlike the classic “Citramon”, is a drug with film-coated tablets. This makes oral administration easier.

The effect on the body is complex:

Acetylsalicylic acid reduces temperature and resists inflammatory processes.
Caffeine stimulates excitation processes in the central nervous system and activates the brain.
In combination with acetylsalicylic acid and paracetamol, the drug has a pronounced analgesic effect.

The product is available freely and does not require a prescription. Stored at normal room temperature up to 25 degrees. The shelf life is 2 years from the date of production.

For reference

One of the common types of the drug is Citramon P. Along with the main components, it contains paracetamol, which enhances the analgesic and antipyretic effect.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Citramon is a combined drug, the effect of which is determined by the properties of the components it contains (non-narcotic analgesic, psychostimulant and NSAID).

ASA relieves fever and inflammation, relieves pain (especially if the pain is caused by an inflammatory process), has a moderate antiplatelet effect, prevents the formation of blood clots, and helps improve microcirculation in the area of inflammation.

Paracetamol reduces the intensity of pain, reduces fever, and has a weak anti-inflammatory effect. The properties of this substance are associated with its influence on the thermoregulation center located in the hypothalamic region and a weakly expressed ability to inhibit the formation of Pg in peripheral tissues.

Caffeine has a direct stimulating effect on the central nervous system, which manifests itself in the form of increased excitation processes in the cerebral cortex, vasomotor and respiratory centers, increased motor activity and strengthened positive conditioned reflexes.

Stimulates mental activity, temporarily reducing or eliminating drowsiness and fatigue, and shortens reaction time. Reduces platelet aggregation.

Citramon tablets contain caffeine in low concentrations. Because of this, the substance has virtually no stimulating effect on the central nervous system, but improves cerebral vascular tone and helps accelerate blood flow.

The combination of ASA and paracetamol potentiates the analgesic effect of the drug. Both the analgesic and antipyretic effects of ASA and paracetamol are enhanced when these substances are used simultaneously with caffeine.

Pharmacokinetics

After oral administration, the components contained in the tablets are absorbed quickly and almost completely. At the same time, caffeine helps to increase F (bioavailability) of ASA and paracetamol.

During absorption, it and ASA are intensively biotransformed with the formation of pharmacologically active metabolites. Salicylic acid is formed from ASA through the process of deacetylation in the liver and intestinal wall .

Under the influence of the hepatic isoenzyme CYP1A2, caffeine forms dimethylxanthines ( paraxanthine and theophylline ).

The maximum duration of all active components of Citramon is from 0.3 to 1 hour. In blood plasma, from 10 to 15% of paracetamol and approximately 80% of the taken dose of ASA are in an albumin state.

All components of the tablets easily penetrate into any fluids and tissues of the body (including easily crossing the placental barrier and entering breast milk). Minor concentrations of salicylates are found in brain tissue, while levels of caffeine and paracetamol are comparable to plasma levels.

With the development of acidosis, ASA turns into a non-ionized form, due to which its penetration into the tissues of the NS increases.

Metabolism of active substances occurs in the liver. ASA has 4 metabolites (gentisuronic and gentisic acids, salicylophenolic glucuronide, salicylurate). Paracetamol forms sulfate (80% of the total amount) and paracetamol glucuronide (both are pharmacologically inactive), as well as a potentially toxic substance - N-acetyl-benziminoquinone (about 17% of the total amount).

Caffeine metabolites are uridine , mono- and dimethylxanthines, mono- and dimethyluric acid, di- and trimethylallantoin.

Caffeine affects the pharmacokinetics of paracetamol, slightly increasing (up to 20-25%) the formation of N-acetyl-benziminoquinone.

Metabolites are excreted by the kidneys. About 5% of paracetamol, about 10% of caffeine and about 60% of salicylates are excreted unchanged.

The half-life of elimination is from 2 to 4.5 hours (all components of the drug are excreted at approximately the same rate). Increasing the dose of Citramon leads to a slower elimination of ASA compared to other substances by up to 15 hours.

In smokers, on the contrary, there is an accelerated elimination of caffeine in comparison with other components of the drug.

Use for high blood pressure

In Citramon, the instructions for increasing or lowering blood pressure detail all available contraindications for taking Citramon. The guidelines note that treatment is prohibited in the presence of persistently elevated intracranial pressure. Taking it aggravates the condition; before starting therapy, it is necessary to conduct a laboratory diagnostic study and find out why the headache hurts.

Medical signs of high blood pressure include:

cephalalgia - pressing, dull,
impaired visual acuity with a feeling of blurriness,
nosebleeds,
dizziness.

The following symptoms appear with low blood pressure:

Indications for use of Citramon

What is Citramon P for?

When asked what Citramon P helps with, the manufacturer answers in the annotation for the drug that the use of tablets is advisable for relieving mild and moderate pain, as well as for alleviating the patient’s condition during febrile syndrome , which is accompanied by ARVI and influenza .

Citramon is effective for the head (including during migraine attacks), for joint and muscle pain, and algodismenorrhea .

What are Citramon-LekT tablets for?

Indications for the use of Citramon-LekT are the same as for other drugs based on ASA, paracetamol and caffeine, namely: pain syndrome due to algodismenorrhea , neuralgia , myalgia , arthralgia , headache, toothache, migraine.

The drug can also be used as a remedy for fever during acute respiratory viral and influenza .

Does Citramon help with toothache?

Toothache is one of the indications for using the drug. The effectiveness of Citramon is due to the properties of its constituent NSAIDs, non-narcotic analgesic and psychostimulant.

Strengthening each other's action, these components have a complex effect on the body, relieving any pain (including toothache), especially if it is associated with inflammation. During exacerbation of chronic pulpitis , against which the temperature often rises, Citramon not only helps relieve pain and reduce the severity of inflammation, but also has an antipyretic effect.

Characteristics of the drug

The main component in the composition is caffeine. It activates the central nervous system, increases the degree of arousal, and is used for:

activation of respiratory, brain, vasomotor centers,
reducing the lumens of blood vessels,
increased breathing,
muscle relaxation,
stabilization of the heart, diuresis.

Citramon is approved to block several types of headaches. It is used to increase blood pressure levels in a single dose if there are no signs of hypertension. Caffeine allows you to gently gain weight and normalize sleep. Allowed for complex therapy in combination with ergot alkaloids and analgesics.

The second substance is acetylsalicylic acid. Aspirin relieves mild to moderate pain and is used to block the inflammatory process and reduce fever. Can be used as a medicine to prevent arterial or venous thrombosis. The substance helps to temporarily relieve discomfort associated with chronic lupus, rheumatoid arthritis, and osteoarthritis. Included in a complex to reduce the risk of death, the formation of unstable angina or myocardial infarction.

The third substance is paracetamol. The substance is used to eliminate pain and reduce fever. It does not have anti-inflammatory or antiplatelet effects. The substance is added to many medications and eliminates acute respiratory infections in the early stages of their occurrence.

We studied the composition of Citramon. It is aimed at influencing intracranial pressure in the direction of growth. The product does not cause dilation of blood vessels. Citramon increases low blood pressure .

Citramon increases or decreases blood pressure

Contraindications

The instructions list the following contraindications for Citramon:

complete or partial combination of recurrent polyposis /paranasal sinuses, bronchial asthma and intolerance to NSAIDs or ASA (including a history);
hypersensitivity to the components of the tablets;
erosive and ulcerative lesions of the gastrointestinal tract in the acute phase;
gastrointestinal bleeding ;
portal hypertension;
hemophilia;
hypoprothrombinemia;
hemorrhagic diathesis;
vitamin deficiency K;
Severe ischemic heart disease;
severe arterial hypertension ;
renal failure;
deficiency of the cytosolic enzyme G6PD;
pregnancy (especially its first and last trimesters);
lactation;
increased excitability;
glaucoma;
dissecting aortic aneurysm;
sleep disorders;
surgical interventions accompanied by bleeding;
childhood (in children under fifteen years of age with hyperthermia against the background of a viral infection, there is a high probability of developing Reye's syndrome );
concomitant use of anticoagulants .

Relative contraindications are gout and existing liver pathologies.

Contraindications for use

Restrictions associated with the use of the product contain a fairly large list of disorders and diseases:

nasal polyposis;
bronchial asthma;
hypersensitivity to one or more components;
bleeding of the gastrointestinal tract;
diathesis of hemorrhagic type;
erosion, ulcer of the gastrointestinal tract (in the acute stage);
portal hypertension"
severe course of coronary heart disease;
hemophilia;
renal failure;
increased nervous excitability;
kidney failure;
sleep problems;
bleeding during operations;
severe hypertension;
glaucoma;
simultaneous use of anticoagulant drugs;
aortic aneurysm;
pregnancy period (especially during the 1st and 3rd trimesters);
feeding period (any stage);
children up to 15 years old inclusive.

There are also relative contraindications in which Citramon should be taken with caution. These are liver dysfunctions, as well as gout.

Side effects

Side effects of Citramon:

gastralgia , anorexia , nausea, formation of erosions and ulcerative elements on the mucous membrane of the digestive canal, gastric and intestinal bleeding;
liver failure;
hypersensitivity reactions (including the development of symptoms of the Fernand-Vidal triad );
interstitial nephritis , nephrotic syndrome , necrotizing papillitis , with long-term use - renal failure ;
anemia , thrombocytopenia , leukopenia ;
acute fatty hepatosis , toxic hepatitis , acute hepatic encephalopathy ( Reye's syndrome );
worsening heart failure , manifestation of its latent forms (with long-term use);
dizziness, insomnia, agitation, anxiety, headache, tinnitus, hearing and vision impairment, aseptic meningitis ;
increased blood pressure, arrhythmia , tachycardia ;
development of tolerance and weak psychological dependence (with long-term use of high doses of the drug);
drug-induced headache after discontinuation of Citramon (if the drug was used for a long time).

Experiments on animals also demonstrated the teratogenic effect of the drug on the fetus.

Citramon tablets, instructions for use

Preparations from different manufacturers have different compositions, and since they often contain active substances in different concentrations, you should read the instructions very carefully so as not to mistakenly exceed the permissible daily dose.

What all drugs have in common is that they can be used as an analgesic for a maximum of five days, and as an antipyretic for three days.

Instructions for use Citramon P and Citramon-LekT

Citramon P and Citramon-LekT can be taken from the age of fifteen. Take one tablet 2-4 times a day (during or after meals). The break between doses should be at least four hours. The average dose is 3-4 tablets per day.

Citramon for headaches (as well as in other cases when it is necessary to relieve severe pain) can be taken 2 pieces at once. The permissible upper limit of the daily dose is 8 tablets.

Treatment lasts from one week to ten days.

If necessary, the doctor may prescribe a different dose of the drug or select a different treatment regimen.

Instructions for use Citramon Forte

Citramon-Forte is used in patients over sixteen years of age. The daily dose is 2-3 tablets. You need to take them one at a time, 2 or 3 times a day. To relieve an attack of acute pain, you should immediately take two tablets.

The permissible upper limit of the daily dose is 6 tablets.

Citramon-Darnitsa is taken according to a similar regimen (the only difference between the drug is the age limit - these tablets are prescribed from 15 years of age).

Instructions for use Citramon-Borimed

It is preferable to take Citramon-Borimed immediately after meals or between meals. The drug can be used in adults and adolescents over fifteen years of age. Take one tablet 2-3 times a day, maintaining intervals of at least 6-8 hours between doses. The highest single dose is 2 tablets, the daily dose is 4.

It is used as an antipyretic at temperatures exceeding 38.5 °C (if there is a tendency to febrile convulsions - at temperatures above 37.5 °C). Single dose - 1-2 tablets.

Instructions for use of Citramon Ultra

Citramon Ultra is prescribed from the age of fifteen. Daily dose - 1-3 tablets. If necessary, you can take up to 6 tablets during the day.

Citramon

Registration number: P N001793/01

Trade name: Citramon-MFF.

International nonproprietary name (INN): Acetylsalicylic acid + Caffeine + Paracetamol.

Dosage form: Tablets.

Composition per tablet: Active substances:

Acetylsalicylic acid - 0.24 g
Paracetamol - 0.18 g
Caffeine anhydrous - 0.0275* g

Excipients (to obtain a tablet weighing 0.55 g):

Cocoa - 0.0225 g
Citric acid - 0.0050 g
Potato starch - 0.0650 g
Talc - 0.0050 g
Calcium stearate - 0.0050 g* - corresponds to 0.03 g of caffeine monohydrate

Description: Tablets are light brown in color, slightly marbled, with inclusions, flat-cylindrical with a chamfer and a score, with the smell of cocoa.

Pharmacotherapeutic group: Analgesic (NSAID + analgesic non-narcotic + psychostimulant).

ATX code: N02BA71

Pharmacodynamics: Citramon-MFF has analgesic, antipyretic and anti-inflammatory effects. The combined effect of the drug components ensures its effectiveness with low toxicity. Acetylsalicylic acid has analgesic, antipyretic and anti-inflammatory effects. Acetylsalicylic acid has antioxidant properties, helps increase the body's overall resistance and good tolerability of the drug. Paracetamol has an analgesic, antipyretic and extremely weak anti-inflammatory effect, which is associated with its effect on the thermoregulation center in the hypothalamus and a weak ability to inhibit Pg synthesis in peripheral tissues. Caffeine increases the reflex excitability of the spinal cord, stimulates the respiratory and vasomotor centers, dilates the blood vessels of skeletal muscles, brain, heart, kidneys, reduces platelet aggregation; reduces drowsiness, fatigue, increases mental and physical performance. In this combination, caffeine in a small dose has virtually no stimulating effect on the central nervous system, but helps normalize cerebral vascular tone and accelerate blood flow.

Pharmacokinetics: Acetylsalicylic acid: After oral administration, it is absorbed quite completely. During absorption, it undergoes presystemic elimination in the intestinal wall and in the liver (deacetylated). The resorbed part is very quickly hydrolyzed by esterases (T1/2 is no more than 15-20 minutes). The salicylic acid anion circulates in the body. Salicylates easily penetrate into tissues and body fluids, diffusion accelerates in the presence of hyperemia and edema, and slows down in the proliferative phase of inflammation. Salicylates cross the placenta and are excreted in small quantities in breast milk. Biotransformed in the liver with the formation of 4 metabolites; excreted by the kidneys (with alkalinization of urine, excretion increases significantly). Caffeine: Well absorbed in the intestines, half-life is 5 hours (sometimes up to 10 hours). It is excreted mainly by the kidneys in the form of metabolites, about 10% unchanged. Paracetamol: Rapidly absorbed from the gastrointestinal tract. The plasma half-life is 1-4 hours. The maximum concentration in plasma is usually determined 30-60 minutes after ingestion. Metabolized in the liver to form paracetamol glucuronide and sulfate. Excreted by the kidneys mainly in the form of conjugation products, less than 5% is excreted unchanged.

Indications for use: Citramon-MFF is used in adults with moderate or mild pain syndrome (headache, toothache, joint pain, neuralgia, myalgia, dysmenorrhea, etc.) to reduce elevated body temperature during colds and other infectious and inflammatory diseases.

Contraindications:

Increased individual sensitivity to the components of the drug
Peptic ulcer of the stomach and duodenum
Gastrointestinal bleeding
Severe liver or kidney dysfunction
Genetic absence of glucose-6-phosphate dehydrogenase
Blood diseases with a tendency to hemorrhage and bleeding
Glaucoma
Bronchial asthma
I and III trimester of pregnancy and breastfeeding period
Kidney failure
Attack of bronchial obstruction
History of urticaria or acute rhinitis, provoked by taking acetylsalicylic acid or other non-steroidal anti-inflammatory drugs
Hemophilia
Hemorrhagic diathesis
Hypoprothrombinemia
Portal hypertension
Vitamin K deficiency
Confirmed hyperkalemia
Arterial hypertension
Severe ischemic heart disease
Increased excitability
Sleep disorders
Surgical interventions accompanied by bleeding

The drug is not prescribed to children under 15 years of age with acute respiratory diseases caused by viral infections (ARVI, influenza) due to the risk of developing Reye's syndrome.

With caution: Use in elderly people, patients with impaired liver or kidney function (creatinine clearance less than 60 ml/min), and gout. For coronary artery disease, cerebrovascular diseases, congestive heart failure, dyslipidemia/hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking. Anamnestic data on the development of ulcerative lesions of the gastrointestinal tract, long-term use of NSAIDs, concomitant therapy with selective serotonin reuptake inhibitors.

Method of administration and dosage: Citramon-MFF is used orally after meals, 1 - 2 tablets 2 - 3 times a day. The maximum daily dose is 6 tablets. The break between doses is at least 6 hours. In case of impaired renal or liver function, the interval between doses of the drug should be at least 8 hours. The drug should not be used for more than 5 days as an analgesic and for more than 3 days as an antipyretic without a doctor’s prescription and supervision. Other dosages and regimens of use are determined by the doctor.

Side effects: Allergic skin reactions (rash, itching, urticaria), palpitations, dizziness, nausea, pain in the stomach are rarely possible. With long-term use in high doses, liver and kidney dysfunction may occur. Gastralgia, nausea, vomiting, hepatotoxicity, nephrotoxicity, erosive and ulcerative lesions of the gastrointestinal tract, allergic reactions (including Stevens-Johnson syndrome, Lyell), tachycardia, increased blood pressure, bronchospasm. With long-term use, dizziness, headache, visual impairment, tinnitus, decreased platelet aggregation, hypocoagulation, hemorrhagic syndrome (nosebleeds, bleeding gums, purpura, etc.), kidney damage with papillary necrosis; deafness; Reye's syndrome in children (hyperpyrexia, metabolic acidosis, nervous system and mental disorders, vomiting, liver dysfunction). Side effects of the drug, including those not indicated in the instructions, must be reported to your doctor.

Overdose: Do not exceed the recommended dose and duration of use! Symptoms (due to acetylsalicylic acid): For mild intoxication - nausea, vomiting, gastralgia, dizziness, ringing in the ears; In case of severe intoxication - lethargy, drowsiness, collapse, convulsions, bronchospasm, difficulty breathing, anuria, bleeding. Initially, central hyperventilation of the lungs leads to respiratory alkalosis (shortness of breath, suffocation, cyanosis, perspiration). As intoxication increases, progressive respiratory paralysis and uncoupling of oxidative phosphorylation cause respiratory acidosis.

Treatment: If you suspect poisoning, you should immediately seek medical help. The victim should undergo gastric lavage using activated charcoal.

Interaction with other drugs: The drug enhances the effect of drugs that reduce blood clotting and platelet aggregation, as well as the side effects of glucocorticoids, sulfonylurea derivatives, methotrexate, non-narcotic analgesics and non-steroidal anti-inflammatory drugs. Enhances the effect of reserpine and hypoglycemic agents. Reduces the effectiveness of spironolactone, furosemide, antihypertensive drugs, as well as anti-gout drugs that promote the excretion of uric acid. Barbiturates, rifampicin, salicylamide, antiepileptic drugs and other stimulants of microsomal oxidation promote the formation of toxic paracetamol metabolites that affect liver function. Metoclopramide accelerates the absorption of paracetamol. Under the influence of paracetamol, T1/2 of chloramphenicol increases 5 times. When taken repeatedly, paracetamol may enhance the effect of anticoagulants (dicoumarin derivatives). The simultaneous use of paracetamol and ethanol increases the risk of developing hepatotoxic effects. Caffeine accelerates the absorption of ergotamine. The use of other medications should be discussed with your doctor.

Special instructions: Do not prescribe the drug to children under 15 years of age due to the high risk of Reye's syndrome. Reye's syndrome is manifested by prolonged vomiting, acute encephalopathy, and liver enlargement. Acetylsalicylic acid slows down blood clotting. If the patient is undergoing surgery, you should notify the doctor in advance about taking the drug. In patients with a predisposition to the accumulation of uric acid, taking the drug may provoke an attack of gout. During use, you should refrain from drinking alcohol (increased risk of gastrointestinal bleeding and toxic liver damage). Acetylsalicylic acid, when used in the first trimester of pregnancy, has a teratogenic effect; in the third trimester - can lead to inhibition of labor. It is excreted in breast milk, so use during lactation is contraindicated.

Release form: Tablets. 6 or 10 pieces per blister pack or 10 tablets per blister pack. 2 or 3 blister packs of 10 tablets each, or 2 or 3 blister packs of 6 or 10 tablets, together with instructions for use, are placed in a cardboard box. It is allowed to pack outline cellular and non-cellular packaging together with an equal number of instructions for use in a cardboard box.

Storage conditions: In a dry place at a temperature not exceeding +25 °C. Keep out of the reach of children.

Shelf life: 4 years. Do not use after expiration date.

Conditions for dispensing from pharmacies: Without a doctor's prescription.

Overdose

A slight overdose manifests itself in the form of nausea, dizziness, increased pallor of the skin, gastralgia, vomiting, and ringing in the ears.

Symptoms of severe intoxication of the body: impaired circulation and breathing, anuria , anxiety, stupor, nausea, headache, hyperthermia , tremor , drowsiness, anxiety, sweating, collapse , bleeding, convulsions (with pathological increased tendon reflexes), coma .

If signs of overdose appear, taking the tablets should be stopped. To prevent the absorption of the drug in the digestive canal, the patient's stomach is washed, enterosorbents and a saline laxative are given.

If the plasma concentration of salicylates in a child exceeds 300 mg/l, and in an adult - 500 mg/l, it is advisable to carry out forced alkaline diuresis. To maintain urine pH at 7.5-8, alkalizing agents are administered.

Measures are taken to restore the bcc and acid-base balance.

In case of cerebral edema, mechanical ventilation with an oxygen-enriched mixture is prescribed in the mode of creating PEEP (positive end-expiratory pressure). Hyperventilation should be carried out in combination with the use of osmotic diuretics .

If there are signs of liver damage, N-acetylcysteine, which is a specific antidote to paracetamol, should be administered. The solution is used orally and injected into a vein. In total, the patient needs to administer seventeen doses: the first - 140 mg/kg, all subsequent doses - 70 mg/kg.

The most effective therapy is started in the first ten hours after the development of intoxication. If more than 36 hours have passed, treatment is ineffective.

When the prothrombin index (PTI) value increases to 1.5-3, the use of phytomenadione ( vitamin K ) in a dose of 1 to 10 mg is indicated. If the PTI exceeds 3.0, infusion of clotting factor concentrate or native plasma should be started.

Carrying out hemodialysis, using antihistamines , corticosteroids or acetazolamide (to alkalinize urine) during intoxication with Citramon is contraindicated.

These measures can provoke the development of acidemia and increase the toxic effect of ASA on the patient’s body.

Interaction

It is strictly forbidden to prescribe in combination with Citramon with:

MAO inhibitors (when used simultaneously with caffeine , these drugs can lead to a dangerous increase in blood pressure);
Methotrexate at a dose exceeding 15 mg/week. (this combination increases the hematological toxicity of methotrexate).

Citramon also enhances the toxicity of barbiturates and valproic acid , the effects of opioid analgesics, oral hypoglycemic and sulfonamide agents, Digoxin and triiodothyronine .

Phenytoin , ethanol , COCs, Rifampicin , tricyclic antidepressants, barbiturates, Phenylbutazone increase the toxicity of paracetamol to the liver.

Macrolides ( Erythromycin , Clarithromycin ), interferon preparations, antimycotic agents ( Fluconazole , Ketoconazole ) slow down the metabolism of the active substances of Citramon tablets and lead to an increase in their concentration in plasma.

The use of the drug in combination with platelet , indirect anticoagulants and thrombolytic agents increases the risk of bleeding.

By inhibiting the synthesis of Pg in the kidneys, it weakens the effect of potassium-sparing and loop diuretics, as well as antihypertensive drugs from the group of ACE inhibitors.

GCS increase the toxicity of the components of the tablets on the gastric mucosa, increase the clearance of ASA and reduce its plasma concentration.

In combination with beta-adrenergic agonists ( Fenoterol , Salbutamol , salmeterol ) in high doses, the risk of developing hypokalemia ; with methylxanthines , the level of theophylline in plasma increases and the risk of its toxic effect increases; with Li salts, the plasma concentration of Li+ ions increases.

Due to the competitive excretion of uric acid in the nephron tubules, it weakens the effect of uricosuric drugs.

special instructions

Abuse of caffeine-containing products during treatment with Citramon can provoke overdose symptoms.

Elderly people, people suffering from gout , impaired renal and/or liver function with benign hyperbilirubinemia should be careful when taking tablets.

In patients with allergic complications (allergic rhinitis, asthma, urticaria ), when they are combined with respiratory tract infections, as well as with increased sensitivity to NSAIDs during treatment, bronchospasm or asthma attacks are possible.

With long-term (more than five days in a row) use of Citramon, monitoring of the functional state of the liver and peripheral blood patterns is necessary.

Long-term use of tablets containing paracetamol in high cumulative doses in some cases can cause drug-induced nephropathy or irreversible renal failure .

Long-term use of painkillers to treat headaches often leads to chronic headaches.

Taking Citramon can distort laboratory test indicators such as: plasma concentration of uric acid, plasma concentration of Heparin , plasma concentration of theophylline, blood sugar level, concentration of amino acids in the urine.

The drug may alter doping control tests in athletes. It complicates the diagnosis of “acute abdomen”.

In case of long-term treatment with Citramon, you should consult a doctor before taking Ibuprofen .

The use of drugs containing ASA during surgical interventions (including dental operations) increases the likelihood of the occurrence/intensification of bleeding.

The drug may affect the rate of neuromuscular transmission, and therefore during the period of treatment they should refrain from driving a vehicle or operating dangerous machinery.

The effect of the drug on blood pressure. Do Citramon tablets increase or decrease blood pressure?

Headaches are a fairly common occurrence in people prone to changes in blood pressure. Therefore, questions naturally arise here: is it possible to take the medicine with high blood pressure, is the drug harmful for hypotensive patients, how are Citramon and blood pressure related?

The analgesic effect for headaches is provided primarily due to the presence of ASA and paracetamol in the tablets.

The third component of the drug - caffeine - increases the flow of oxygen to tissues, stimulates blood circulation in the brain and increases blood pressure, thus helping to reduce the intensity of headaches and enhancing the effects of other components of Citramon.

High doses of caffeine provoke depression of the central nervous system. When taking small doses (as, for example, in Citramon), the stimulating effect predominates.

It should be noted that while caffeine increases blood pressure, which is reduced during hypotension, it does not change normal blood pressure.

Low pressure exposure

Among the list of medical symptoms of low blood pressure are: dizziness, problems with the quality of vision - this is especially felt when driving a car. All of these symptoms indicate low blood pressure and can cause loss of concentration and sluggish reactions. The symptoms can be easily suppressed with Citramon.

Low blood pressure indicates other pathologies. A list of popular diseases and conditions is presented below:

excessive bleeding
complex course of infection,
dehydration,
heart attack or heart failure,
severe allergic reaction,
diseases of the endocrine system affecting the thyroid gland, low blood sugar, and the formation of diabetes mellitus.

I wonder if Citramon increases or decreases blood pressure ? Doctors do not recommend taking the drug frequently to improve blood pressure levels. The drug has a short-term effect and is not indicated for long-term treatment. Thanks to the caffeine it contains, the medicine increases blood pressure rather than lowers it. Caffeine is present in many common foods that people consume every day. Coffee fans feel addicted to it. A similar condition occurs with frequent use:

strong black tea,
sweet soda,
energy workers.

People who prefer these drinks feel a constant need for caffeine. The use of tablets that contain it does not affect intracranial pressure and does not increase it.

Analogs

Level 4 ATC code matches:
Acetylsalicylic acid

Aspirin-S

Citropak

Aspirin

Coficil-Plus

Farmadol

Askofen-P

Cefekon N

Aquacitramon

Upsarin UPSA

Citrapack

Alca Prim

Thrombopol

Citrapar

Analogs with the same composition of active ingredients:

Citramon-Darnitsa
Citramon-Borimed
Citramon-Ultra
Citramon-LekT
Aquacitramon
Atsepar
Askofen-P
Cofficil-plus
Citrapar
Excedrin
Migrenol Extra

Similarities of drugs

The unconditional similarity of all drugs is their composition. In all of them, the content of active ingredients is present in the following concentration:

contains the most aspirin – 0.24 g;
also quite a lot of paracetamol - 0.18 g;
and very little caffeine – 0.03 g.

It is this combination of these ingredients that allows you to relieve pain, relieve inflammation, and also have a slight psychostimulating effect.

All medications are available in the form of light brown tablets. They have a characteristic smell of cocoa and are heterogeneous in color (there are inclusions of a darker color).

Can children take Citramon?

The use of ASA-containing drugs for the treatment of ARVI in children (with or without hyperthermia

With some viral infections (particularly those caused by varicella zoster or influenza A or B ), there is a risk of developing acute hepatic encephalopathy ( Reye's syndrome ), which requires immediate medical attention. One of the signs of Reye's syndrome is prolonged vomiting.

Taking into account the above reasons, the use of tablets in patients under sixteen years of age is contraindicated.

Since the drug has a large number of side effects, it is better for children with a headache or toothache to choose safer remedies.

Citramon P

If you look for analogues of Citramon in pharmacies, then the first thing they offer is this medicine. In fact, now this drug is identical in composition to regular Citramon. The letter P in the name appeared when pharmacists replaced phenacetin with paracetamol. Previously, phenacetin was one of the main active ingredients. They replaced it because it had many side effects.

In its action it is similar to Citramon, lowering the temperature and relieving pain, it also has an anti-inflammatory effect and acts as a psychostimulant. And the spectrum of action of Citramon P is similar to regular Citramon.

Alcohol compatibility

During treatment with Citramon, you should avoid drinking alcohol, since alcohol increases the likelihood of a toxic effect of paracetamol on the liver and ASA on the gastrointestinal tract.

The use of ethyl alcohol with ASA contributes to damage to the mucous membrane of the digestive canal. The synergism of alcohol and ASA also results in prolongation of bleeding time.

Citramon for hangover

Citramon for a hangover is not the most advantageous option, since the use of this drug allows you to relieve headaches only temporarily, but does not eliminate the main causes of poor health - imbalance of water and electrolytes, as well as intoxication.

The headache that accompanies hangover syndrome is associated with impaired venous outflow from the head, tissue swelling (in particular, swelling of the meninges ) and inhibition of the analgesic (antinociceptive) system, part of which is the action of serotonin and dopamine.

ASA partially unloads the membranes of the brain, caffeine stimulates metabolism in neurons and has an invigorating effect, cocoa reduces the relative deficiency of intracerebral serotonin and dopamine, citric acid reduces the severity of symptoms of alcohol intoxication.

However, the paracetamol contained in the tablets puts a lot of strain on the liver, which, in combination with alcohol breakdown products, can aggravate hangover symptoms and damage the body.

Citramon during pregnancy and lactation

Can pregnant women drink Citramon?

During pregnancy, you should avoid taking Citramon tablets, since the ASA they contain has a teratogenic effect.

The use of Citramon during pregnancy in the 1st trimester can cause cleft palate ; the use of the drug in the 3rd trimester leads to a deterioration in labor (suppression of Pg synthesis) and closure of the ductus arteriosus in the fetus. This in turn provokes hyperplasia of the pulmonary vessels and increased pressure in the vessels of the pulmonary (pulmonary) circulation.

Thus, the answer to questions like “Can I drink Citramon during pregnancy?” and “Can pregnant women take Citramon?” unambiguous - impossible.

Can a nursing mother take Citramon while breastfeeding?

The use of the drug during hepatitis B is contraindicated. The active components of the tablets and their metabolites are excreted into breast milk, which increases the likelihood of platelet dysfunction and bleeding in the baby.

Citramon-LekT tablet x20

Citramon-LekT tablet x20, ATX code: N02BA51 (Acetylsalicylic acid in combination with other drugs (excluding psycholeptics))

Active substances

paracetamol Rec.INN registered by WHO acetylsalicylic acid Ph.Eur. European Pharmacopoeia caffeine Ph.Eur. European Pharmacopoeia

Dosage form

CITRAMON-LECT

tab. 0.24 g+0.18 g+ 0.0275 g: 10 or 20 pcs.reg. No.: LP-001188 from 11.11.11 - Valid

Release form, composition and packaging

Tablets 1 tab.

acetylsalicylic acid 0.24 g

paracetamol 0.18 g

anhydrous caffeine 0.0275 g, Clinical-pharmacological group: Analgesic-antipyretic combined composition Pharmaco-therapeutic group: Analgesic non-narcotic drug (NSAID + psychostimulant + non-narcotic analgesic) The scientific information provided is general and cannot be used to make a decision on the possibility of using a specific drug .

pharmachologic effect

Combined drug.

Acetylsalicylic acid has an antipyretic and anti-inflammatory effect, relieves pain, especially caused by the inflammatory process, and also moderately inhibits platelet aggregation and thrombus formation, improves microcirculation at the site of inflammation.

Caffeine increases the reflex excitability of the spinal cord, stimulates the respiratory and vasomotor centers, dilates the blood vessels of skeletal muscles, brain, heart, kidneys, reduces platelet aggregation, reduces drowsiness, fatigue, and increases mental and physical performance. In this combination, caffeine in a small dose has virtually no stimulating effect on the central nervous system, but helps normalize cerebral vascular tone and accelerate blood flow.

Paracetamol has an analgesic, antipyretic and extremely weak anti-inflammatory effect, which is associated with its effect on the thermoregulation center in the hypothalamus and a weak ability to inhibit the synthesis of prostaglandins in peripheral tissues.

Indications

Pain syndrome of mild and moderate severity (of various origins): headache, migraine, toothache, neuralgia, myalgia, arthralgia, algodismenorrhea.

Feverish syndrome: with acute respiratory infections, with influenza.

ICD-10 codes

Dosage regimen

Taken orally (during or after meals) every 4 hours. On average, take 3-4 times a day. The maximum frequency of administration is 8 times/day. The course of treatment is no more than 7-10 days.

If kidney or liver function is impaired, the interval between doses is at least 6 hours.

The drug should not be taken for more than 5 days when prescribed as an analgesic and more than 3 days when prescribed as an antipyretic. Other doses and regimens of use are determined by the doctor.

Side effect

From the digestive system: gastralgia, nausea, vomiting, hepatotoxicity, erosive and ulcerative lesions of the gastrointestinal tract.

From the urinary system: nephrotoxicity,

Allergic reactions: skin manifestations, Stevens-Johnson syndrome, Lyell's syndrome, bronchospasm.

From the cardiovascular system: tachycardia, increased blood pressure,

With long-term use: dizziness, headache, visual impairment, tinnitus, decreased platelet aggregation, hypocoagulation, hemorrhagic syndrome (including nosebleeds, bleeding gums, purpura), kidney damage with papillary necrosis, deafness, Reye's syndrome in children (hyperpyrexia, metabolic acidosis, nervous system and mental disorders, vomiting, liver dysfunction).

Contraindications for use

Hypersensitivity to the components of the drug, erosive and ulcerative lesions of the gastrointestinal tract (in the acute phase), gastrointestinal bleeding, “aspirin” asthma, hemophilia, hemorrhagic diathesis, hypoprothrombinemia, portal hypertension, vitamin deficiency K, renal failure, I and III trimesters of pregnancy, period lactation (breastfeeding), deficiency of glucose-6-phosphate dehydrogenase, severe arterial hypertension, severe ischemic heart disease, glaucoma, increased excitability, sleep disturbances, surgical interventions accompanied by bleeding, childhood (under 15 years - the risk of developing Reye's syndrome in children with hyperthermia against the background of viral diseases).

With caution: gout, liver disease.

Use during pregnancy and breastfeeding

Contraindicated for use in the first and third trimesters of pregnancy and during lactation (breastfeeding).

Acetylsalicylic acid has a teratogenic effect; when used in the first trimester of pregnancy, it leads to a malformation - cleft palate, in the third trimester - to inhibition of labor (inhibition of prostaglandin synthesis), to closure of the ductus arteriosus in the fetus, which causes pulmonary vascular hyperplasia and hypertension in the fetus. vessels of the pulmonary circulation.

It is excreted in breast milk, which increases the risk of bleeding in the baby due to impaired platelet function.

Use for liver dysfunction

Caution: liver diseases.

Use for renal impairment

Contraindicated in renal failure.

Use in children Children under 15 years of age should not be prescribed medications containing acetylsalicylic acid, since in the case of a viral infection they can increase the risk of Reye's syndrome. Symptoms of Reye's syndrome are prolonged vomiting, acute encephalopathy, and liver enlargement.

special instructions

Children should not be prescribed medications containing acetylsalicylic acid, since in the case of a viral infection they can increase the risk of Reye's syndrome. Symptoms of Reye's syndrome are prolonged vomiting, acute encephalopathy, and liver enlargement.

With prolonged use of the drug, monitoring of peripheral blood and the functional state of the liver is necessary.

Since acetylsalicylic acid slows down blood clotting, the patient, if he is undergoing surgery, must notify the doctor in advance about taking the drug.

In patients with hypersensitivity or asthmatic reactions to salicylates or their derivatives, acetylsalicylic acid can only be prescribed with special precautions (in an emergency setting).

Acetylsalicylic acid in low doses reduces the excretion of uric acid. In patients with a corresponding predisposition, this can in some cases provoke an attack of gout.

During treatment, you should stop drinking ethanol (increased risk of gastrointestinal bleeding).

Drug interactions

Strengthens the effect of heparin, indirect anticoagulants, reserpine, steroid hormones and hypoglycemic drugs.

Co-administration with other NSAIDs and methotrexate increases the risk of side effects.

Reduces the effectiveness of spironolactone, furosemide, antihypertensive drugs, as well as anti-gout drugs that promote the excretion of uric acid.

Barbiturates, rifampicin, salicylamide, antiepileptic drugs and other stimulants of microsomal oxidation contribute to the formation of toxic paracetamol metabolites that affect liver function.

Metoclopramide accelerates the absorption of paracetamol.

Under the influence of paracetamol, T1/2 of chloramphenicol increases 5 times. When taken repeatedly, paracetamol may enhance the effect of anticoagulants (dicoumarin derivatives).

The simultaneous use of paracetamol and ethanol increases the risk of developing hepatotoxic effects.

Caffeine accelerates the absorption of ergotamine.

Reviews

Most people, despite the fact that the drug is considered potentially unsafe, leave good reviews about Citramon, calling it their savior from headaches (including migraine attacks).

Although there are also those that mention the dangers of tablets for the liver and gastrointestinal tract, and also that with long-term use they cause a kind of addiction (patients can no longer do without Citramon for a long time and experience a constant need for it).

Based on all available reviews, the following conclusion can be drawn: the pills should be taken taking into account existing contraindications, as well as having previously compared the expected benefits from them and potential risks.

One or two tablets taken to relieve an attack of pain are not capable of harming the body; systematic, uncontrolled use, of course, threatens with very serious consequences.

Citramon price

The price of Citramon depends on which company produced the drug. So, for example, the price of Citramon P is from 15 rubles, and the price of Citramon Ultra is from 50 rubles.

In Ukraine, a package of tablets can be purchased from 5 to 20 UAH.

Online pharmacies in RussiaRussia
Online pharmacies in UkraineUkraine
Online pharmacies in KazakhstanKazakhstan

ZdravCity

Citramon P tablets 20 pcs. AO Update PFK
81 rub. order
Citramon P tablets 10 pcs. JSC "PFK Obnovlenye"
58 RUR order
Citramon-ExtraCap capsules 240 mg + 27.45 mg + 180 mg 10 pcs. Pharmstandard-Leksredstva OJSC
73 rub. order
Citramon P tablets 30 pcs. JSC Medisorb
44 RUR order
Citramon-LekT tab. No. 20 JSC "Tyumen Chemical Plant"
38 rub. order

Pharmacy Dialogue

Citramon-P Update tablet No. 10Update PFK CJSC
64 RUR order
Citramon-ultra tablets No. 20PharmVilar
76 RUR order
Citramon-ultra tablets No. 20 PharmVilar NPO LLC/Obolenskoye FP JSC
81 RUR order
Citramon-ultra tablets No. 10 Obolenskoe pharmaceutical company.
55 rub. order
Citramon-P tablets No. 10FS.-Leksredstva
11 rub. order

Pharmacy24

Citramon-M No. 6 tablets PAT "Khimpharmzavod" Chervona Zirka", Kharkov, Ukraine
4 UAH. order
Citramon Fitofarm forte N12 capsules PRAT "Fitofarm", Ukraine
20 UAH order
Citramon-M No. 10 tablets PAT "Khimpharmzavod" Chervona Zirka", Kharkov, Ukraine
5 UAH order
Citramon Euro N10 tablets Mibe GmbH Arznam., Germany
32 UAH order
Citramon-forte No. 100 tablets PAT "Lubnipharm", Ukraine
85 UAH order

PaniPharmacy

Citramon In tablet Citramon In tablet. No. 6 Ukraine, Lubnyfarm PJSC
3 UAH order
Citramon F tablets Citramon tablets. No. 6 Ukraine, Fitofarm ChAO
4 UAH order
Citramon M tablets Citramon-M tablets. No. 10 Ukraine, Red Star JSC
6 UAH order
Citramon tablets Citramon-Darnitsa tablets No. 6 Ukraine, Darnitsa ChAO
7 UAH order
Citramon tablets Citramon-Darnitsa tablets No. 10 Ukraine, Darnitsa ChAO
13 UAH order